Tag Archives: mandibular osteotomy

The last time I posted I was just getting started on training for my third marathon, which was going to be Space Coast. Had everything continued as normal I would be racing this weekend. Shortly after my last post (a week or two) I was at my surgeon’s office for a routine check-up when he said I looked ready but confirmation from the orthodontist was necessary before moving forward. The next time I went in to see the orthodontist I had him take a closer look. He agreed with the surgeon that I appeared ready but wanted to take models and have both doctors of their 2 orthodontist team to evaluate and confirm. So finally after a couple weeks of agonizing over whether I was ready, when surgery would be, would Space Coast happen, I got word that I was ready and to go ahead and schedule the surgery. This all happened mid-September and because of various appointments that had to happen before (2 sets of models, surgical hooks and wires and a physical), surgery wasn’t on the books until November 6th. Space Coast Marathon was definitely off. This gave me plenty of time to worry, stress and obsess. One word can describe how I felt: overwhelmed. Luckily I have an amazing support system of friends, family and coworkers getting me through all the headaches that arose prior to surgery.

Fast forward to November, an event packed month! My birthday was on the 1st and we met my Daddy and Step-Mom in Orlando for a relaxing pre-surgery weekend away.

The day before surgery was full of good eats: Five Guys for lunch with my coworkers and steak and cupcakes with Mike for dinner.

We arrived at the hospital on November 6th at 530am for my 730am surgery. Pre-op was what I was used to (this was my third surgery) except for having to use a nasal spray for the intubation tube that would go up my nose. I need to note here that I HATE anything up my nose, including snot, so this was actually horrifying for me. I knew I would be intubated but I didn’t know that it would be through my nose. They gave me some drugs to relax and I don’t remember much after that.

Three hours later and it was all done. The procedure was fairly routine with the only real hiccup being that I lost 700mL of blood rather than the normal 300mL. I also was awake when they removed the intubation tube in the recovery room. I should not have been awake when they did this. I can’t even describe how horrifying that was. Warning: there are many unflattering photos ahead. I originally wasn’t going to post ANY of these but ultimately decided to. In the days when the swelling was at it’s peak and I was afraid of the face in the mirror, seeing other people’s real-life experiences helped me get through the dark moments.

This is when they brought me to my room. I’m awake and NOT happy (see the furrow in my brow?). My Mom took this as proof of life for my relatives waiting to hear any news. 🙂 Not to worry though, a few hits of my Morphine button and I was feeling OK (I took the below photo for Jena).

I have to give my Mom HUGE THANKS for being my own private nurse and taking such amazing care of me. I have the best Mom in the whole world and I don’t know how Mike and I would have gotten through this without her. Also a huge thanks to Mike who, after spending all day at the hospital, went home to find the dogs had gotten sick in their crates and continued to get sick all night. He took excellent care of me and is now a master of the blender.The one thing that I was most afraid of was vomiting because my mouth was tightly banded. With the amount of blood I lost (some of which was sitting in my stomach) the surgeon added an oral liquid Iron supplement to my meds. The combination of these things led to me vomiting. I was so scared but my Mom was right there rubbing my back and telling me over and over I was going to be OK and that we would get through it. This of course happened in front of my Father-in-law! Thanks Jim for not not only visiting but for refraining from throwing up too! 😉

After that drama the rest of the stay was routine. My Daddy and Step-Mom were even able to come visit! It worked out great that they were staying in Orlando for the week, they live in New York. I was discharged in the early evening of the next day so only one night stay in the hospital! I was honestly a little afraid to go home where I didn’t have instant access to a full team of medical professionals and equipment but once I got home I was so glad to be in my own bed (and use my own toilet!).

No pictures of me from this day (day 1) because when I looked in the mirror I was terrified of what I saw. Words can’t describe how horrifying it is to look in the mirror and see such drastic swelling in your face. I looked like a monster. So instead here are the flowers I received (from my mom and step-dad, my work family and my orthodontist):

So, how do I look?

My jaw in xray form:

You can see in the above photo the plates and screws that will be there forever. If you look closely you can see the dark spots in my jaw, that’s where there is very little bone after it being cut and moved. As my jaw heals the bone will fill in, my osteoblasts are working overtime!

Day 2 swelling (significantly less than day 1):

Day 5 swelling:

Day 6 swelling (my right side [left side of the picture]was worse off than the left and my smile is crooked):

Day 8 swelling (you can see the green bruise on my neck in this pic):

Day 10 swelling:

Day 16 swelling (Thanksgiving! Me and my big brother):

Day 18 swelling (yesterday- Go Gators!!):

As of today the swelling in the right side of my face has been greater than the left. I have a hematoma on that side that has been very slowly dissolving. For the first week I was using ice in a jaw bra provided by the hospital and then the surgeon had me switch to heat on the hematoma (I use a heating pad). Overall I’m pleased with how the healing has been going. I can’t say if the TMJ pain is gone yet because I still have some residual soreness from surgery and I also haven’t chewed anything since the day before surgery. That conclusion is pending further evaluation.

How bad was the pain?

Honestly, not as bad as I was expecting. I took hits of Morphine in the hospital every few hours (I was allowed every 5 minutes) and had liquid prescription pain killers at home that I took every few hours for the first 2 days at home (Wednesday and Thursday). Friday and Saturday I only took the drugs before bed to help me sleep and Saturday night was the last time I took them at all. I describe it more as being uncomfortable from all the pressure the swelling was putting on my face rather than actual pain. I’ve taken some extra strength tylenol on days with a lot of activity (like Thanksgiving) and when I’ve had orthodontic adjustments. As far as numbness goes, at first everything was numb. Slowly the feeling has been coming back and now I only have a small spot that is semi-numb and very (annoyingly) tingly. It is the right half of my bottom lip down to the right half of my chin. Hence the crooked smile seen in the photos.

What have I been eating?

For the first week everything was through a straw, mostly because I couldn’t open wide enough for a fork. In addition to protein smoothies, Mike would dump cans of soup into the blender, puree it and heat it up (I would drink that through a straw). Once I was able to take out the rubber bands for eating and cleaning, I started adding in anything that could be swallowed with a baby fork or spoon. This included egg salad, tuna salad, mashed sweet potatoes, anything that could be shredded into small pieces and lubricated with [non-dairy] butter or mayo. Eventually I graduated to adult forks and spoons as I got my range of motion back. For veggies I bought the Peter Rabbit Organics pureed fruit and veggie packets (they taste better than they sound) and Bolthouse Farms Green Goddess juice. I drink fruit smoothies with protein added and also just protein shakes. I’ve also continued to take my multi-vitamin. Unfortunately I’ve lost 12 pounds, every single bit of it muscle. I’m desperate to get back to lifting so I can gain my hard-earned muscle weight back!

Oral Hygiene

Since my orthodontist commented that I had excellent oral hygiene (without any inquiries from me) for a surgery patient I thought I’d share what I did. Disclaimer: make sure you follow your doctors instructions and ask before altering any routine you do now. I am not a doctor, this is just what worked for me. About a week before surgery I went to the dentist and had a full clean. I let the dentist and the hygienist know what procedure I was having done. They were so incredibly thorough (and gentle) and removed every last bit of plaque and junk that was on my teeth. I also got a baby toothbrush from them while I was there. My incisions were inside my mouth and my cheeks were too swollen to pull them back so initially I used the baby toothbrush on only the teeth I could see and my tongue. I followed this up with rinsing with warm salt water and then with Listerine Zero (has no alcohol). This was my routine for the first week and I did this after every time I ate. Once I was able to remove my rubber bands for cleaning I also started using my Waterpik (with the surgeon’s approval) on the low setting with the orthodontic tip. By this time I could pull my cheek back and see exactly where the incisions were so I could brush all my teeth and waterpik all my teeth carefully without hitting the incision. I continued the warm salt water rinse and Listerine Zero rinse through the second week. After the second week I dropped the warm salt water rinse and went back to the normal Listerine. It’s so important to keep your mouth clean and avoid infection, that is a complication you don’t want to have to deal with!

Something else I’ll highly recommend! Chapstick, chapstick, chapstick!!! I lost about 3 layers of skin from my lips in the first 2 days and I’m soooo glad I couldn’t feel them at that point! I immediately started using a tube of softlips I had gotten in a race bag (thanks Women’s Half Marathon!) and Aquaphor:

Trust me, you want your lips to be slathered in that stuff at all times!

What about exercise?

At my one week post-op appointment the surgeon cleared me for exercise with obvious limitations. I have to be very careful of falling and any lifting has to be with great care with my face. Up until this point I’ve only attempted cardio (which has greatly suffered because of the amount of blood lost!) including walking, running, riding my bike on an indoor trainer and rowing. I’m planning to return to FitCrew next week, modified obviously.

When the surgery was scheduled I knew Space Coast wasn’t going to happen. I had been stalking Chris Lauber’s (Florida Road Race Director) Facebook page when he posted that the Clearwater Marathon was in the midst of being relaunched for January 20th, 2013. The day that registration opened Dave and I registered as two of the first 50 people for $50. As of right now I’m confident that I’ll be able to participate but I may have to let go of the sub-4 hour goal. Prior to surgery I ran an 18 miler and my training pace indicated sub-4 was possible but with the huge loss of blood (and therefore Oxygen carrying red blood cells) my pace has drastically slowed. At this point I’ll honestly just be happy to run a full marathon, my favorite race distance, so close to home.

I know this post has been insanely long so thanks for reading!! I hope this helps anyone preparing for this procedure [Mandibular Osteotomy] and if you have ANY questions please ask in the comments section! [If you’re finding this blog for the first time- my lower jaw was 11mm too short which caused an overbite. This led to joint pain (TMJ) as well as degeneration of my right joint. The mandibular osteotomy was done to alleviate the TMJ pain and stop the degeneration of my right joint.]